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COVID-19 is associated with traumatic childbirth and subsequent mother-infant bonding problems.

  • Mayopoulos, Gus A1
  • Ein-Dor, Tsachi2
  • Dishy, Gabriella A1
  • Nandru, Rasvitha1
  • Chan, Sabrina J1
  • Hanley, Lauren E3
  • Kaimal, Anjali J3
  • Dekel, Sharon4
  • 1 Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA.
  • 2 School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel. , (Israel)
  • 3 Massachusetts General Hosptial, Department of Obstetrics and Gynecology, Boston, MA, USA; Harvard Medical School, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, USA.
  • 4 Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA. Electronic address: [email protected]
Published Article
Journal of affective disorders
Publication Date
Mar 01, 2021
DOI: 10.1016/j.jad.2020.12.101
PMID: 33412491


Knowledge of women's experience of childbirth in the outbreak of the coronavirus (COVID-19) pandemic and associated maternal health outcomes is scarce. A sample of primarily American women who gave birth around the height of COVID-19 (n = 1,611) and matched controls, i.e., women who gave birth before COVID-19 (n = 640), completed an anonymous Internet survey about recent childbirth, birth-related traumatic stress (peritraumatic distress inventory; PTSD-checklist), maternal bonding (maternal attachment inventory; mother-to-infant bonding scale) and breastfeeding status. Groups (n = 637 in each) were matched on demographics, prior mental health/trauma and childbirth factors to determine the unique contribution of COVID-19 to the psychological experience of childbirth. Mothers in COVID-19-exposed communities endorsed more clinically acute stress response to childbirth than matched controls (Z = 2.65, p = .008, OR= 1.38). A path mediation model revealed that acute stress mediated the relationship between study group and postpartum outcomes. Specifically, higher acute stress response in birth was associated with more childbirth-related posttraumatic stress disorder symptoms (β = .42, p < .001) and less bonding with the infant (β = .26, p < .001), including breastfeeding problems (β = .10, p < .01). Use of a convenient internet sample introduces bias towards more educated women and reliance on retrospective self-report assessments may entail recall bias. COVID-19 is a major stressor for delivering women. It can heighten traumatic childbirth experiences and interfere with successful postpartum adjustment. Clinical attention to traumatic stress in childbirth and problems with caring for the young during this pandemic is important. Copyright © 2020. Published by Elsevier B.V.

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